Fergus O'Dowd (Louth, Fine Gael)
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I welcome the Minister of State, Deputy Finian McGrath, to the House. I acknowledge his commitment to improving services, especially in the area of disability and care.

Serious issues arise in terms of safeguarding all people who are in care in nursing homes, disability centres and children's services. While I acknowledge the vast majority of staff who work in the homes and institutions are dedicated, committed, caring and compassionate, there are serious problems with the quality of care in many centres. Safeguarding legislation is urgently needed. I call on the Minister of State and Members on all sides of the House to act collectively so that we have effective action and a determined Taoiseach to lead a new Cabinet subcommittee to advance the best possible legislation to protect citizens. That must become an immediate priority for the Government. We measure society in terms of how we care for and protect those who are most vulnerable, weak and at risk.

It is almost a year ago since I started to find out exactly what was going on in HIQA, what information it got and what it did with it. Under freedom of information HIQA very kindly decided to charge me the sum of €11,000 to get to the bottom of the situation. Thankfully, when I appealed to the Information Commissioner he quashed HIQA's decision. I will now outline some of the facts that I found.

I will deal with disability centres first, of which we have more than 1,000. There are more than 8,800 residents in the centres and there were 8,177 notifications of concern about care and welfare. Some 4,600 of them were about suspected or confirmed abuse, which is more than 52%. A total of 1,364 related to cases of serious injuries by the residents that required immediate medical or hospital treatment. There were 2,726 allegations of physical abuse, more than 1,000 of psychological abuse and more than 209 of sexual abuse. Some 14% of disability centres were referred to the HIQA regulation risk committee, and 20% of service providers were required to attend meetings to discuss their level of non-compliance with HIQA regulations. A total of 9% of registered centres have additional non-standard conditions applied to their current registration.

A total of 51 centres were issued with a notice of proposal to cancel or refuse their registration, and to date only 18 have registered. There are very serious problems in the centres. In spite of all the thousands of notifications HIQA received, both unsolicited and mandated information, there has been no investigation by HIQA or anyone else into the allegations. There is no memorandum of understanding between the Garda and HIQA. There were discussions on one but it did not happen and that is unacceptable. I have been in touch with the Ombudsman who is ready, willing and able to take up all of those cases if they are sent to him, but that has not happened to date.

We need the Minister of State's support and we need reform. The Government must be committed to that. I know the Minister of State is personally committed to the introduction of safeguarding legislation to ensure each allegation is investigated and that we protect the most vulnerable. During my supplementary questions I will deal with the response of the Minister of State and nursing homes.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy O'Dowd for raising this issue and for the opportunity to respond to the House. The safety and protection of vulnerable people in the care of the State is paramount. The Government's primary concern, and my concern, is that their needs are being prioritised and addressed. More than 23,000 older people and 8,500 people with a disability are in receipt of residential care in Ireland from more than 1,600 service providers. The Health Information and Quality Authority, HIQA, is the statutory independent regulator for residential services in the disability and older persons sectors. HIQA has published standards against which it registers residential services for older people and those with a disability. The standards establish the requirements for people living in residential care to ensure high-quality, safe and effective services which promote person-centred care, uphold the rights of people, respect privacy and dignity, and protect people living in residential care from abuse and neglect. Service providers must ensure that all reasonable measures are taken to protect residents from all forms of abuse. They must have policies and procedures in place for the prevention and detection of abuse and the response to it. Many people do not know that. Furthermore, operators must notify HIQA of any allegation of abuse or serious adverse incident that occurs in a residential centre. HIQA welcomes information about designated centres for dependent persons, reviews all information about services received, and calculates it against the regulations and standards. If there is a serious risk to the health and welfare of persons accessing the service, HIQA may decide to take appropriate action.

A report by HIQA on the use of information gathered and received in the regulation of services was received by my Department this week and we are examining this very useful document. The report outlines how unsolicited information and mandated monitoring notifications are received and reviewed by an inspector of social services who assesses the related risk and decides on a regulatory response. Every piece of information received, whether unsolicited or mandated, is reviewed in such a manner. I know that some concerns were raised recently in the media about the manner in which unsolicited information received by HIQA was dealt with. HIQA reports that in 2017, a total of 820 pieces of unsolicited information were received in connection with older persons' services. In the case of 342 of those pieces of information, further information or a provider-led investigation of the issue identified was requested following initial review and risk rating of the information. Review of the unsolicited information triggered 17 targeted inspections. HIQA concluded that none of the issues raised by the unsolicited information required referral to other organisations. HIQA reports that in the case of disability services, from 2,911 pieces of unsolicited information, further investigation or provider-led investigation was requested in 140 cases, ten targeted inspections were triggered and none of the issues raised by the unsolicited information required referral to other organisations.

Where referrals are required, they take place. In the case of children’s services, 13 of the 108 pieces of unsolicited information received were signposted to Tusla’s complaints process, the Office of the Ombudsman, the Office of the Ombudsman for Children and the health and social care professionals regulator, CORU. I note that HIQA is very open and transparent regarding the information it gathers in its regulation of services and publishes an annual report.

Fergus O'Dowd (Louth, Fine Gael)
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I again ask the Minister of State to commit to bringing forward legislation to protect all vulnerable people. These concerns have not been dealt with. There was no investigation of individual cases and none of the people affected was consulted. One in every six persons living in a nursing home - a total of 30,000 persons - was the subject of a care and welfare mandatory notification or unsolicited information given to HIQA, while in the past year one in every 12 suffered serious injuries requiring immediate medical or hospital treatment. That is entirely unacceptable. Some 4% or more than 1,338 of those residents suffered a fracture or fractures, while 3% or 899 cases involved confirmed or alleged abuse, including 366 cases of physical abuse, 138 of psychological abuse and 68 of sexual abuse. Some 9% of all nursing homes were referred to the HIQA regulatory risk committee, while 18% had additional non-standard conditions applied to their registration and almost 20% had to attend meetings to discuss regulatory non-compliance.

The report did not just land on the desk of the Minister of State. Rather, it was prompted by my freedom of information request and the decision of the Information Commissioner to take action on the attitude displayed HIQA towards transparency, as referred to by the Minister of State, and accountability. I have met representatives of HIQA, the Information Commissioner and senior gardaí on the issue. I ask the Minister of State to commit, as I believe he can and will, to bringing forward safeguarding legislation to protect all such vulnerable people because these cases involve serious issues which are not being dealt with. It is unacceptable that the human rights of some of the most vulnerable in society are compromised, yet none of the thousands of complaints received by HIQA was considered.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy O'Dowd for casting light on this very important issue which the Government takes very seriously. It is very important that any allegations are comprehensively dealt with. The safety and protection of vulnerable people in the care of the State is paramount and my primary concern is that their needs are prioritised and addressed. The progressive development of quality care within these services is clearly demonstrated in the inspection reports regularly published by HIQA. My Department received the HIQA report earlier this week on the use of information gathered and received in the regulation of services. I have noted the steps taken relating to the handling of these issues, including decisions made in terms of referrals to other organisations.

On the safeguarding of vulnerable people at risk, of course, I support the main point put forward by Deputy O'Dowd, namely, that the Health Service Executive have a national safeguarding policy and procedure to protect vulnerable people at risk of abuse. That policy was published in 2014 and is now under review by the HSE. It is anticipated that the review will be completed by the end of 2018.

On legislation, the Government approved the development of the health sector adult safeguarding policy and work is under way to develop a clear, consistent and carefully considered and implemented policy platform including legislation as may be required. I agree with the points raised by Deputy O'Dowd. The Government is committed to bringing forward legislation on this issue.